Table of Content

10 March 2022, Volume 3 Issue 2 Previous Issue    Next Issue

Special Article

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Application of comprehensive unit-based safety program coordinated with action strategy in reducing central line associated blood stream infection WEI Jianhua, SANG Ming, ZHANG Ping, SUN Chunrong, LI Xufang, HE Lingying, WENG Fengxia, YANG Su, WANG Huafen 2022, 3 (2):  101-106.  doi: 10.3761/j.issn.2096-7446.2022.02.001 Abstract ( )   PDF (887KB) ( )   Save Objective To evaluate the effect of comprehensive unit-based safety program（CUSP） coordinated with action strategy on reducing the incidence of central line associated blood stream infection（CLABSI） in ICU patients. Methods The CUSP coordinated with action strategy intervention program was developed to reduce CLABSI by identifying the existing problems related to the incidence of CLABSI in ICU. The program was continuously applied in ICU and the intervention measures were dynamically adjusted during the application process from July 2019 to June 2021. The incidence of CLABSI,nurses' knowledge and practice of CLABSI,the implementation rate of central venous catheter-related maintenance items and hand hygiene compliance were compared before（July 2017 to June 2019） and after the intervention（July 2019 to June 2021）. Results The incidence of CLABSI in 14 681 catheter days before intervention was 0.82‰,while the incidence of CLABSI in 15 055 catheter days after intervention was 0.27‰,with statistical significance（P<0.05）. Before the intervention the ICU nurses' knowledge,attitude and practice score of CLABSI was （96.84±8.00）,and the score was （99.35±7.96） after the intervention,the difference was statistically significant（t=-2.016,P<0.05）. The implementation rate of central intravenous catheter maintenance was 82.73% before intervention and 92.74% after intervention（ χ2=4.735,P<0.05）. The hand hygiene compliance rate was 51.21% before the intervention and 85.33% after the intervention（ χ2=26.563,P<0.05）. Conclusion The adoption of comprehensive unit-based safety program coordinated with action strategy can reduce the incidence of CLABSI,improve the knowledge and practice of CLABSI,the implementation rate of central venous catheter maintenance and hand hygiene compliance of ICU nurses. References | Related Articles | Metrics

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Construction of trauma treatment and nursing management system in Gansu province WANG Xue, FAN Luo, LIU Shaoguang, LI Lin 2022, 3 (2):  107-115.  doi: 10.3761/j.issn.2096-7446.2022.02.002 Abstract ( )   PDF (1208KB) ( )   Save Objective To establish the system of trauma treatment and nursing management to promote the development of trauma nursing in Gansu province. Methods Based on literature research and expert interviews,21 trauma experts were consulted for two rounds to construct the system of trauma treatment and nursing management in Gansu province. Results In the two rounds of letter consultation,the positive coefficients of the experts were 100%,the authority coefficient was 0.82,and the Kendal harmony coefficient of the first,second and third indexes was 0.31,0.43,0.37 respectively. Finally,Gansu province trauma treatment and nursing management system was formed with 5 first-level indexes（organizational structure,personnel management,environmental goods and process management,information management and quality control）,20 second-level indexes and 107 third-level indexes. Conclusion The trauma treatment and nursing management system constructed in Gansu province is scientific and reliable,and provides the corresponding treatment mechanism and management system for the trauma treatment and nursing management in Gansu province. References | Related Articles | Metrics

Special Planning—Nursing Care of Critically Ill Pregnant and Postpartum Women

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Clinical application of obstetric emergency triage scale XIANG Zhenzhen, JIN Jingfen, FENG Suwen, XU Lingyan, ZENG Wanting, SU Shuihong 2022, 3 (2):  116-120.  doi: 10.3761/j.issn.2096-7446.2022.02.003 Abstract ( )   PDF (832KB) ( )   Save Objective To investigate the application effect of the obstetric emergency triage scale. Methods The data of 4 286 emergency obstetric patients from three tertiary class A obstetrics and gynecology hospitals in Zhejiang province from December 2020 to January 2021 were statistically analyzed,including disease classification,destination,triage target response time. We tested the consistency of triage levels rated by the nurses and expert group. Results The percentage of level Ⅰ,level Ⅱ,level Ⅲ,level Ⅳ among obstetric patients were 1.2%,16.5%,73.2% and 9.0% respectively. The hospitalization rate were 96.2%,76.6%,46.3% and 0.5%. The triage target response time were 100.0%,96.8%,97.7%,and 100% respectively. The consistency Kappa value between nurses and expert group was 0.961[95%CI（0.950,0.970）]. Conclusion The obstetric emergency triage scale has high sensitivity and practicality,and has high consistency among clinical assesors. References | Related Articles | Metrics

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Investigation of coping difficulties in the mothers of premature infants in the neonatal intensive care unit and influencing factor analysis TENG Xiaoyun, WEI Qin, HE Ting, LIANG Jie, LIANG Hua, TAN Jilei, HUANG Xiaobo, TANG Lihua 2022, 3 (2):  121-126.  doi: 10.3761/j.issn.2096-7446.2022.02.004 Abstract ( )   PDF (1626KB) ( )   Save Objective To explore the current situation of coping difficulties in mothers of premature infants in the neonatal intensive care unit（NICU） and analyze the influencing factors. Methods Using the convenience sampling method,a total of 200 mothers of premature infants were investigated by the general information questionnaire,Post-Discharge Coping Difficulty Scale-New Mother Form（PDCDS）,the Parent Perception of Uncertainty Scale（PPUS）,and Family APGAR Index（APGAR） in the NICU of a tertiary hospital in Nanning,Guangxi from October 2020 to August 2021. Results The total score of 200 mothers for coping difficulties was （6.82± 0.89）,the total score of disease uncertainty was （89.26± 8.69）,and the total score of family function was （6.59± 1.54）. Multiple linear regression analysis showed that monthly household income per capita,lack of information,and family dysfunction were the main influencing factors of coping difficulties in mothers of premature infants（P< 0.05）. Conclusion The coping difficulties among mothers of premature infants in NICU were in the middle level. Educational guidance should be strengthened for mothers of premature infants with low monthly family income,lack of information support and family dysfunction,so as to reduce their coping difficulties. References | Related Articles | Metrics

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Research progress on early warning tools and nursing intervention of critically ill pregnant and postpartum women DUAN Liangyuan, XU Lingyan, LIU Ningning, WANG Yueqin 2022, 3 (2):  126-130.  doi: 10.3761/j.issn.2096-7446.2022.02.005 Abstract ( )   PDF (1285KB) ( )   Save Early identification and treatment of critically ill pregnant and postpartum women is the key to reduce maternal mortality. This paper reviews the high-risk factors of critically ill pregnant and postpartum women,the application status of early warning evaluation tools and the research progress of nursing intervention. In recent years,many early warning tools for pregnant women have been developed abroad,which play an important role in identifying and intervening early and reducing the incidence rate of critical maternal diseases. However,there is no domestic early warning and assessment tool for critically ill pregnant and postpartum women. Optimizing the quality of pregnancy health management,establishing a group pregnancy management model,strengthening the management of high-risk pregnant women and establishing an obstetric rapid response team will help to reduce the avoidable maternal mortality. References | Related Articles | Metrics

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The emergency nursing of a woman with amniotic fluid embolism whose first symptom was gingival bleeding HU Xiaoli, QIU Rulan, WU Luping, LI Yacen 2022, 3 (2):  131-134.  doi: 10.3761/j.issn.2096-7446.2022.02.006 Abstract ( )   PDF (758KB) ( )   Save To summarize the emergency nursing of a woman with amniotic fluid embolism（AFE） whose first symptom was gingival bleeding. For atypical AFE,early identification and advanced life support are keys to manage AFE. Collaboration and precise decision-making of multi-disciplinary rapid response team,complete management of rescue equipment,daily mock drills and continuous procedure optimization are important factors to improve the success rate of AFE rescue. After rescue and specialized nursing,the puerpera and newborn were in good condition,the patient was discharged 12 days later and prognosis was good. References | Related Articles | Metrics

Clinical Research

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Design and application of “Internet Plus” based admission process in emergency and critical patients ZENG Jia, GUO Meiying, XIAO Tao, XIE Wenzhao, CAO Dun, WANG Sha, LIU Huan, NING Ni 2022, 3 (2):  135-139.  doi: 10.3761/j.issn.2096-7446.2022.02.007 Abstract ( )   PDF (729KB) ( )   Save Objective To design and apply the admission process based on "Internet Plus" in emergency and critical patients. Methods The hospital admission process of emergency critically ill patients was optimized through literature review and group discussion methods,and patients' family members paid online by mobile application and Wechat public account,nurses in emergency department handled admission procedures online,and the "Internet Plus" hospital admission process was developed. 124 critically ill patients who were admitted to the emergency department and hospitalized from January 2021 to March 2021 were selected as the experimental group. The experimental group used the “Internet Plus” hospital admission process. A total of 94 critically ill emergency patients who were admitted and hospitalized from October 2020 to December 2020 were selected as the control group and used the traditional admission procedures. The completion time and satisfaction of admission procedures between the two groups were compared. Semi-structured interviews were conducted to understand the medical staff's opinions on the “Internet Plus” admission process. Results The completion time of admission procedures in experimental group was 20.84 min shorter than that in control group（P< 0.05）. Nursing satisfaction of experimental group was 96.8%,and that of control group was 25.5%,and the difference between the two groups was statistically significant（P< 0.05）. Ten interviewed medical staff recognized the effects of the “Internet Plus” admission process and put forward effective suggestions. Conclusion The “Internet plus” emergency hospital admission process for emergency and critically ill patients can shorten hospital waiting time and improve patient satisfaction. References | Related Articles | Metrics

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Risk factors of extravasation in patients with intraosseous infusion YANG Minfei, WANG Weifen, WANG Haihong, CHEN Bin, ZHAN Yue, YAO Xiaoyue 2022, 3 (2):  140-144.  doi: 10.3761/j.issn.2096-7446.2022.02.008 Abstract ( )   PDF (735KB) ( )   Save Objective To analyze the risk factors of extravasation in emergency patients with intraosseous infusion,to provide early assessment and screening of extravasation in patients with intraosseous infusion. Methods We retrospectively analyzed the data of 358 patients with bone marrow cavity infusion in three hospitals in Zhejiang Province from January 2017 and December 2020. The patients were divided into two groups according to whether there was any extravasation. Compared the differences of clinical indicators in two groups,analyzed independent factors of extravasation in patients with intraosseous infusion by Logistic regression model. Results A total of 15 patients（4.18%） were found to have extravasation. Multivariate Logistic regression analysis showed that Body Mass Index（BMI）,pain grade,transport times,intraosseous retention time were independent risk factors for extravasation. The position of catheterization and previous experience of catheterization were independent protective factors（P< 0.05）. Conclusion Nurses should pay attention to obese patients, and patients with intraosseous tube in the humeral site and obvious pain, and reduce moving the patients,try to arrange experienced nurses to guide the rescue. References | Related Articles | Metrics

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Nursing of repair and reconstruction for severely mangled legs in patients WANG Xiaofei, WANG Ping, ZHU Jinxia, LAN Meijuan 2022, 3 (2):  145-147.  doi: 10.3761/j.issn.2096-7446.2022.02.009 Abstract ( )   PDF (589KB) ( )   Save The nursing experience of repair and reconstruction for severely mangled legs in 32 patients was reported. In view of the risk of acute renal failure after severe trauma,the possibility of vascular crisis after vascular and skin flap transplantation,and the failure of negative pressure closure drainage of wound,infection of external bone fixation needle tract and cross infection of multiple drug-resistant bacteria,the monitoring of renal function should be strengthened after operation,and we combined with percutaneous oxygen saturation monitoring to judge the blood circulation of the affected limb,and grasped the observation method and opportunity of skin flap. The needle care program was implemented in stages and the patients infected with multi-drug-resistant bacteria were seperated into different rooms or treated independently. All the 32 cases got successful limb salvage,the average hospital stay was 21 days. They were followed up for more than 1 year,25 cases had satisfactory functional evaluation,5 cases had basic functional recovery,2 cases retained the function of the affected limb to the maximum extent and had walking lameness with pain. References | Related Articles | Metrics

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Emergency nursing of septic shock in children with acute lymphoblastic leukemia and agranulocytosis CHEN Xiuping, ZHOU Hongqin, XIE Wangfang, ZHU Jihua, WANG Yanqing 2022, 3 (2):  148-151.  doi: 10.3761/j.issn.2096-7446.2022.02.010 Abstract ( )   PDF (690KB) ( )   Save To retrospectively analyze the clinical features and emergency nursing experience of septic shock in 25 cases with acute lymphoblastic leukemia and agranulocytosis. The patients' condition was critical and progressive due to the deficiency of immune system. Through nursing observation,the nurse identified early specific clinical manifestations of septic shock,cooperated with doctors to take cluster emergency nursing measures including initial fluid resuscitation within one hour,large dose of hormones and the application of empirical antibiotics,giving high flow oxygen to optimize tissue oxygen delivery and other symptomatic nursing measures. Shock was effectively corrected in this group of cases. References | Related Articles | Metrics

Quality and Safety

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Design and application of micro-course for Glasgow Coma Scale score JIANG Yun, HUANG Shuangxia, CUI Miaoling, ZHONG Juan, QU Jingting, LIU Liudong, BI Wenliang 2022, 3 (2):  152-156.  doi: 10.3761/j.issn.2096-7446.2022.02.011 Abstract ( )   PDF (831KB) ( )   Save Objective To explore the key points of the design and application effects of the Glasgow Coma Scale（GCS） score micro-course. Methods A specialized micro-course teacher team was developed and designed GCS micro-course based on the five stages of ADDIE model（analysis,design,development,implementation and evaluation）,the survey and interview. The GCS micro-course was applied to the clinical teaching of 60 full-time undergraduate nursing students in an emergency department and EICU for four weeks of rotation internship. The teaching effects were evaluated using the achivement of knowledge goal,ability goal and emotional goal,satisfaction,participation of nursing students before and after the training. Results After training,the theoretical scores of nursing students was higher than that before training[（86.25± 4.84） vs （54.00± 9.69）,P< 0.001] and the pass rate of skills assessment was higher than before（88.33% vs 18.33%,P< 0.001）. Satisfaction with micro-course works,instructional design based on the ADDIE model,and teaching teachers were 100%,96.6% and 96.9%,respectively,with 100% participation. Conclusion The GCS micro-course aroused the interest of nursing students,improved their comprehensive abilities such as knowledge,skills,and emotional attitudes,enriched clinical nursing teaching resources. References | Related Articles | Metrics

Evidence Synthesis and Practice

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Summary of best evidence for hyperglycemia management in ICU enteral nutrition patients WANG Wei, QU Hua, CHU Jing, MENG Deping 2022, 3 (2):  157-162.  doi: 10.3761/j.issn.2096-7446.2022.02.012 Abstract ( )   PDF (792KB) ( )   Save Objective To search,evaluate,and integrate evidence on hyperglycemia management in ICU enteral nutrition patients and summarize the best evidence. Methods We searched European Society for Parenteral and Enteral Nutrition Network,American Society for Parenteral and Enteral Nutrition Network,Joanna Briggs Institute （JBI） Evidence-based Health Care Database,Cochrane Library,OVID Evidence-Based Database,UpToDate,PubMed,Embase,CINAHL,Wanfang Database,VIP Chinese Scientific and Technical Journal Database,CNKI and SinoMed Database for clinical practice guidelines,systematic review,original studies and other evidence. The literature quality and evidence level were evaluated using the literature evaluation criteria and evidence grading system of Australia JBI Evidence-based Health Care Center. Results A total of 13 literatures were included,and 19 best evidences were collected from 5 aspects：nutrition screening and evaluation,routes and formulation selection of enteral nutrition,use of enteral nutrition pump and infusion speed control,blood glucose monitoring,and hyperglycemia management. Conclusion It is suggested that clinical departments should comprehensively evaluate the environment and policies of medical institutions,as well as the promotion and obstacle factors of evidence application when applying evidence. And the clinical departments should implement multidisciplinary cooperation of blood glucose management model in enteral nutrition patients,standardize enteral nutrition and blood glucose clinical practice,strengthen the training and communication for collaboration of medical staff,so as to reduce patients' glucose safely and stably,improve nutritional status and quality of life. References | Related Articles | Metrics

Review

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Research progress of enteral nutrition application management in severe burn patients DU Yong, XIA Yilan 2022, 3 (2):  163-167.  doi: 10.3761/j.issn.2096-7446.2022.02.013 Abstract ( )   PDF (739KB) ( )   Save Severe burn patients need a lot of nutrients because of increased energy consumption, high metabolic rate and body recovery. Timely and reasonable nutritional support is conducive to the healing of burn wounds. This paper reviews the management points of enteral nutrition in severe burn patients,including the application timing,route selection,caloric calculation,component selection,infusion speed,temperature regulation and precautions for the application of enteral nutrition in patients with turnover bed,in order to provide reference for standardizing the management of enteral nutrition in patients with severe burn and improving the outcome of patients. References | Related Articles | Metrics

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Research on influencing factors and intervention of nurses' interprofessional collaboration in ICU FU Wenyao, ZHUANG Yiyu 2022, 3 (2):  168-172.  doi: 10.3761/j.issn.2096-7446.2022.02.014 Abstract ( )   PDF (631KB) ( )   Save In the rapidly developing medical environment,the working mode of interprofessional collaboration has not only become an important measure to ensure the safety and effectiveness of medical services for ICU patients,but also an important strategy to improve the working environment of ICU nursing,nurses' working efficiency and nursing service quality. This article mainly reviews the influencing factors of interprofessional collaboration among ICU nurses,the application of interprofessional collaboration in ICU nurses,and put forward some suggestions about developing scientific interprofessional team training mode and constructing standardized interprofessional collaboration practice process in the future,to providing reference for improving the interprofessional collaboration ability of ICU nurses in medical teams and guiding interprofessional collaboration and education development. References | Related Articles | Metrics

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Research progress of family intervention in the prevention and treatment of delirium in ICU patients JIAO Xueping, LIU Ruiyun, LI Wenjuan, JI Yanhui, MA Yanan 2022, 3 (2):  173-176.  doi: 10.3761/j.issn.2096-7446.2022.02.015 Abstract ( )   PDF (587KB) ( )   Save This review summarizes the connotation,intervention forms and application effects of family intervention in the prevention and treatment of delirium in ICU,aiming to explore the potential positive effects of family-centered care in the prevention and treatment of delirium in ICU patients,so as to provide reference for relevant research and education on delirium in ICU patients. References | Related Articles | Metrics

Clinical Practice

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Nursing of septic shock caused by fusarium infection in a patient with severe burn WANG Zhi, ZENG Fei, HU Hao, FANG Xiao, DONG Siqi, FENG Xiuqin 2022, 3 (2):  177-179.  doi: 10.3761/j.issn.2096-7446.2022.02.016 Abstract ( )   PDF (577KB) ( )   Save To summarize the nursing of septic shock caused by Fusarium infection in patient with severe burn. Nursing points：active fluid resuscitation and strength of fluid management. During the change of dressing,the infected wound and dressing should be strictly managed to avoid the spread of infection. Nurses optimized the management of wound negative pressure suction; strengthened eye protection to prevent infectious keratitis; enhanced environmental cleaning and disinfection to avoid cross-infection. The vital signs of the patient became stable and the infection was effectively controlled after two months of anti-inflammatory treatment, but the patient's family gave up the treatment for financial reasons later. References | Related Articles | Metrics

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Nursing of a child with complicated neurogenic pulmonary edema after surgery for brain stem tumor ZHENG Hong, SHENG Meijun, ZHU Lina, YE Feiya 2022, 3 (2):  180-183.  doi: 10.3761/j.issn.2096-7446.2022.02.017 Abstract ( )   PDF (813KB) ( )   Save To summarize the nursing experience of complicated neurogenic pulmonary edema after the surgery in a child with brain stem tumor. Important nursing points：early identification and efficient emergency care,strengthening of airway management and improving the body's oxygen supply,restrictive liquid management and target sedative analgesia management,and psychological care. After active treatment and nursing,the child was transferred to neurosurgery department after the postoperative condition was stable on the 10th day after surgery,and recovered and discharged on the 33rd day after the surgery. References | Related Articles | Metrics

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Nursing care of multiple gastrointestinal fistulas after operation in a patient with acute hemorrhagic necrotizing enteritis WANG Qunmin, WANG Qin, WANG Feixia, WU Guosheng, LIU Chaoxu 2022, 3 (2):  183-186.  doi: 10.3761/j.issn.2096-7446.2022.02.018 Abstract ( )   PDF (703KB) ( )   Save This article summarized the nursing experience of multiple gastrointestinal fistulas after operation in a patient with acute hemorrhagic necrotizing enteritis and septic shock. The patients had severe postoperative infections,poor nutritional status,multiple incisions and fistulas with close location and large excretion. Multi-disciplinary joint evaluation,diagnosis and treatment were conducted. Nursing measures included implementing empirical combined antibiotic therapy according to multiple drug-resistant bacterial infections with different strains,dynamic adjustment of total intravenous nutrition formula,inhibition of digestive juice secretion,psychological support and etc. And nurses used vacuum sealing drainage technology,separated the areas of incisions and fistulas for management,selected appropriate ostomy bags to effectively collect fistula excrement and avoid leakage,to promote the healing of the incision. The patient's infection was controlled 30 days after the operation,the abdominal incision was healed,and the fistula functioned well. The patient can take care of himself 4 months after the operation,which laid the foundation for the later treatment. References | Related Articles | Metrics

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Nursing care a diffuse panbronchiolitis patient combined with Type Ⅱ respiratory failure LI Qin, WANG Mengzhou, FEI Qiuna, LU Beiyi, YUAN Yefeng 2022, 3 (2):  187-189.  doi: 10.3761/j.issn.2096-7446.2022.02.019 Abstract ( )   PDF (546KB) ( )   Save To summarize the practical experience of nursing in patients with diffuse panbronchiolitis. The patient had dyspnea because of hypoxemia and hepercapnia,respiratory dysfunction because of sputum coughing difficulty and specific histopathological changes. The main points of nursing included：taking targeted oxygen therapy strategy and implementing precise expectoration technology,staged respiratory function exercises. The patient was improved and discharged from the hospital 16 days later. References | Related Articles | Metrics

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Postoperative nursing care of a patient with allograft small bowel transplantation combined with abdominal wall transplantation LU Lu, LU Fangyan, DAI Yanhong, YAO Caiping, TAO Yuxia, ZHANG Wanying 2022, 3 (2):  190-192.  doi: 10.3761/j.issn.2096-7446.2022.02.020 Abstract ( )   PDF (559KB) ( )   Save To summarize the postoperative nursing experience of a patient with allogeneic small bowel transplantation combined with abdominal wall transplantation. In view of the critical condition of the patient,complicated surgery,difficult stoma care and other problems,the observation and care of the abdominal wall skin and transplanted intestinal stoma were strengthened,personalized nutritional support throughout the entire process and combined immunosuppressive programs were adopted. After careful treatment and nursing of multi-disciplinary cooperation,the patient was successfully transferred from the intensive care unit to the general ward for rehabilitation on the 42th day after operation. References | Related Articles | Metrics